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ACA Now

2901 - Special Rule Relating to Indians

 
Implementation Status 
Statutory Text 

Summary

Specifies that there may be no cost-sharing applied to Indians whose income is at or below 300% of the FPL and is enrolled in a QHP in the individual market in the Exchange.  Clarifies that health care programs operated by the IHS, Indian tribes, tribal organizations, and urban Indian organizations are the payer of last resort.  Adds Indian tribes and tribal organizations to the list of recognized entities that may assist with enrollment of Indians under the Express Lane Eligibility (ELE) option.

#Cost-Sharing, #Health Insurance Exchanges, #Qualified Health Plans

Implementation Status

 
Summary 
Statutory Text 

CMS in the spring of 2012 finalized a rule establishing the Exchange and QHPs in which it finalized special Exchange enrollment periods and the reductions in cost-sharing for Indians pursuant to this provision.

On August 8, 2013, featured on the IHS director’s blog, was a letter providing guidance to Tribal leaders regarding emergency services at non-IHS sites and applicable IHS payer of last resort provisions.

On Nov. 12, CMS announced the award of $3.9M to support Medicaid and CHIP outreach and enrollment efforts targeting American Indian and Alaska Native (AI/AN) children.

2015

Of note, in a Feb. 3 blog post, SAMHSA leaders detail the role of the ACA in enhancing access to behavioral health services to the American Indian/Alaska Native (AI/AN) community

Statutory Text

 
Implementation Status 
Summary 

SEC. 2901 [25 U.S.C. 1623]. SPECIAL RULES RELATING TO INDIANS. (a) NO COST-SHARING FOR INDIANS WITH INCOME AT OR BELOW 300 PERCENT OF POVERTY ENROLLED IN COVERAGE THROUGH A STATE EXCHANGE.—For provisions prohibiting cost sharing for Indians enrolled in any qualified health plan in the individual market through an Exchange, see section 1402(d) of the Patient Protection and Affordable Care Act. (b) PAYER OF LAST RESORT.—Health programs operated by the Indian Health Service, Indian tribes, tribal organizations, and Urban Indian organizations (as those terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) shall be the payer of last resort for services provided by such Service, tribes, or organizations to individuals eligible for services through such programs, notwithstanding any Federal, State, or local law to the contrary. (c) FACILITATING ENROLLMENT OF INDIANS UNDER THE EXPRESS LANE OPTION.—Section 1902(e)(13)(F)(ii) of the Social Security Act (42 U.S.C. 1396a(e)(13)(F)(ii)) is amended— (1) in the clause heading, by inserting ‘‘AND INDIAN TRIBES AND TRIBAL ORGANIZATIONS’’ after ‘‘AGENCIES’’; and (2) by adding at the end the following: ‘‘(IV) The Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization (as defined in section 1139(c)).’’. (d) TECHNICAL CORRECTIONS.—Section 1139(c) of the Social Security Act (42 U.S.C. 1320b–9(c)) is amended by striking ‘‘In this section’’ and inserting ‘‘For purposes of this section, title XIX, and title XXI’’.

Browse ACA Titles

  • I-Quality, Affordable Health Care for all Americans
  • II-Role of Public Programs
  • III-Improving the Quality and Efficiency of Health Care
  • IV-Prevention of Chronic Disease and Improving Public Health
  • V-Health Care Workforce
  • VI-Transparency and Program Integrity
  • VII-Improving Access to Innovative Medical Therapies
  • VIII-Community Living Assistance Services and Supports (CLASS ACT)
  • IX-Revenue Provisions

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